Here’s the science behind cannabis therapies for pain, inflammation

Cannabis extract is prepared at the Constance Therapeutics laboratory in Richmond. SOURCE: By David Downs – Special To The Chronicle

You can’t blame patients and doctors for being skeptical about marijuana’s efficacy. First off, we don’t smoke any other modern medicine. And there are very few gold-standard clinical trials for marijuana. Plus, activists hype pot’s curative properties for everything under the sun.

Still, the evidence supporting the safety and efficacy of medical cannabis is plentiful (more than 20,000 studies have been completed on the topic) and the research continues to grow. And this year might be seen as a tipping point.

In a 2017 systematic review of medical studies, researchers from the National Academy of Sciences confirmed there is substantial evidence that cannabis is an effective option for many senior ailments. The landmark 395-page review by the country’s best physicians represents the most current medical conclusions on cannabis, summarizing 10,700 research studies and coming to 100 research conclusions.

Cannabis Therapies for Chronic Pain, Inflammation

The most common use of cannabis is as a pain reliever; surveys of state pot patient populations consistently show that chronic pain is the No. 1 reason people report using medical pot. The data back up the surveys as well. The NAS study reported, “There is conclusive or substantial evidence that cannabis or cannabinoids are effective for the treatment of chronic pain in adults.”

Cell, animal and human trials, as well as patient reports, all confirm cannabis’ efficacy for chronic pain relief. While the review looked at studies on many types of chronic pain (including neuropathy, arthritis, cancer pain, multiple sclerosis, musculoskeletal issues and chemotherapy-induced pain) cannabis was helpful for pain relief regardless of condition.

Cannabis’ broad efficacy is largely due to how it interacts with the “endocannabinoid system” — an electrochemical signaling system in our nerves. This system helps the human body regulate itself. The endocannabinoid system has receptors throughout the body: in the brain, connective tissues, organs, glands and immune cells. When something goes wrong, the endocannabinoid system responds. For example, when someone is injured, cannabinoids made by the body itself can be found at the injured area, decreasing activators and sensitizers in the tissue, calming immune cells to prevent pro-inflammatory substances from being released, and stabilizing the nerve cell to prevent excessive firing. These responses work to minimize pain and damage.

While endocannabinoid receptors are stimulated by the body’s natural endocannabinoids, they also can be stimulated by plant-based cannabinoids, such as those found in cannabis. The main ones active in marijuana include tetrahydrocannabinol (THC) and cannabidiol (CBD). When patients use cannabis medicinally, their natural endocannabinoid system is stimulated by cannabinoids, resulting in reduced pain and inflammation.

A sedative indica strain dubbed Cookies for its aroma. Photo: David Downs

These anti-inflammatory and pain-relieving properties make cannabis an option for ameliorating the daily suffering from common chronic pain conditions like arthritis and neuropathy, which decrease mobility and reduce quality of life.

Cannabis therapies as a safer alternative

Access to cannabis for pain management is especially important for seniors because the pharmaceutical alternatives can be deadly. Since 1999, the prescription opiate market has quadrupled in size, along with the death toll from opiate overdoses. Despite these troubling numbers, opiates are commonly prescribed for chronic pain conditions. Some studies are showing that opioids just don’t work for long-term pain management, even if people can avoid addiction issues.

Once patients start using opiates, they require increasingly larger doses to get pain relief. When safe doses no longer work, patients must live with the pain or risk overdose. Cannabis has no lethal overdose level, making it a safer alternative for patients hoping to avoid this cycle of opiate addiction. In areas where medical cannabis is legal, deaths from opiate overdoses have gone down by 25 percent, according to several peer-reviewed studies, including one in 2016 in JAMA Internal Medicine.

Wide range of cannabis therapies

Beyond relief from pain and inflammation, the National Academy of Sciences also supports the use of cannabis to treat spasticity from spinal cord injuries and other disorders, as well as nausea, lack of appetite, insomnia, anxiety, symptoms of multiple sclerosis, Tourette’s syndrome and post-traumatic stress disorder.

NAS researchers were hesitant to back up the reports that cannabis is an effective treatment for some conditions, including cancer and epilepsy. The NAS also found pot to be ineffective on glaucoma, one of the original reasons patients received the drug. Still, rather than rule out cannabis’ efficacy for these conditions, NAS researchers recommended controlled clinical trials to provide more robust evidence.

While the scientific research is starting to persuade seniors to try cannabis for their medical needs, many still worry about psychoactive side effects. But you don’t have to smoke pot or get high for it to work. Cannabis has many active components, and not all affect patients in ways that cause euphoria.

Research historically focused on THC, a cannabinoid with strong medicinal properties and psychoactive effects. While THC can leave patients feeling “high,” when it’s combined with enough CBD, the psychoactive effects disappear. This type of synergistic effect is called an entourage effect and happens when multiple cannabinoids or terpenes (cannabis’ aroma molecules) are combined. With hundreds of cannabinoids and terpenes, different varieties of cannabis provide an array of effects. Because of this variety, a cannabis specialist can be helpful for directing seniors to the types of cannabis that will work best for their needs.

While more research may expand our understanding of cannabis’ potential uses, the overall results are clear: Cannabis can safely help many seniors now.

Still, an education gap exists for seniors and the doctors who treat them. Doctors note that the endocannabinoid system is not yet taught in medical school. As the research continues to show cannabis’ medical efficacy, reliable cannabis education for doctors and their patients is essential.